The relationship between fatigue and depression and anxiety symptoms among front-line clinical workers during the COVID-19 pandemic (Preprint)

BACKGROUND The initial outbreak of the COVID-19 disease occurred in Wuhan, China around the Spring Festival in 2020. In the face of such a high-intensity catastrophic epidemic response, Chinese doctors and nurses faced huge psychological pressure including fear, anxiety, and depression. OBJECTIVE The purpose of our study is to test the association between front-line clinical workers' fatigue and depression and anxiety during the COVID-19 epidemic. METHODS The current study is a cross-sectional, online survey administered to 275 healthcare professionals in Wuhan from February 22, 2020 to February 29, 2020. All respondents completed a questionnaire via WeChat, which collected demographics and responses on the Self-Rating Anxiety Scale (SAS), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Fatigue Scale-14 (FS-14). RESULTS A total of 275 participants completed the survey, including 46 doctors (16.73%) and 229 nurses (83.27%). Depression was significantly positively associated with physical fatigue (OR 1.61, 95% CI 1.41-1.83), mental fatigue (OR 1.98, 95% CI 1.60-2.45), and the total score (OR 1.56, 95% CI 1.39-1.75) after adjusting for age, occupation, gender, educational background, marital status, having children, years working, job title, and supporting time in Wuhan. Significant positive associations were also observed between the symptoms of anxiety and physical fatigue (OR 1.64, 95% CI 1.44-1.87), mental fatigue (OR 2.11, 95% CI 1.71-2.60), and the total score (OR 1.58, 95% CI 1.42-1.71) in the adjusted model. Similar associations between fatigue, depression, and anxiety were found in the analyses stratified by gender and occupation. CONCLUSIONS The current study demonstrated that, among the front-line clinical workers in Wuhan, fatigue is significantly associated with depression and anxiety and mental fatigue contributes to a greater risk than physical fatigue on the mental health of clinical workers. Males and doctors were found to be more vulnerable to psychological problems such as depression and anxiety under fatigue, suggesting the need for targeted psychological interventions.